Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.36 / $95.22 / $287.95	Facility	26	$51.36	$95.22	$287.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $282.39 / $282.39 / $2,412.21	Professional		$282.39	$282.39	$2,412.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $52.10 / $339.34	Professional	26	$50.12	$52.10	$339.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $232.28 / $232.28 / $2,072.83	Professional	TC	$232.28	$232.28	$2,072.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $172.37 / $177.54 / $182.71	Facility	26	$172.37	$177.54	$182.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $670.34 / $741.57 / $926.96	Professional		$670.34	$741.57	$926.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.41 / $126.44 / $158.05	Professional	26	$117.41	$126.44	$158.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $552.92 / $615.13 / $768.91	Professional	TC	$552.92	$615.13	$768.91
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $272.10 / $423.89 / $1,257.22	Professional		$272.10	$423.89	$1,257.22
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.64 / $83.39 / $160.62	Professional	26	$51.64	$83.39	$160.62
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $220.47 / $377.65 / $795.82	Professional	TC	$220.47	$377.65	$795.82
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $177.54 / $177.54 / $177.54	Facility	26	$177.54	$177.54	$177.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $336.99 / $434.35 / $1,101.80	Professional		$336.99	$434.35	$1,101.80
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $56.97 / $66.11 / $203.02	Professional	26	$56.97	$66.11	$203.02
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $276.06 / $331.27 / $1,097.02	Professional	TC	$276.06	$331.27	$1,097.02
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $177.54 / $182.71 / $309.60	Facility	26	$177.54	$182.71	$309.60
Midlands Facility/Professional Professional Modifier Low / Median / High Price $448.08 / $705.36 / $943.49	Professional		$448.08	$705.36	$943.49
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $55.59 / $288.48 / $514.94	Professional		$55.59	$288.48	$514.94
United Facility/Professional Professional Modifier Low / Median / High Price $333.55 / $383.58 / $741.48	Professional		$333.55	$383.58	$741.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.49 / $63.24 / $110.96	Professional	26	$57.49	$63.24	$110.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $276.06 / $317.47 / $562.73	Professional	TC	$276.06	$317.47	$562.73
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $424.86 / $537.79 / $632.70	Professional		$424.86	$537.79	$632.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $74.42 / $94.20 / $110.80	Professional	26	$74.42	$94.20	$110.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $350.44 / $443.60 / $521.90	Professional	TC	$350.44	$443.60	$521.90